Political Memo; Abortion and the Health Plan: Hard Questions in Both Camps

By ROBIN TONER,

Published: October 22, 1993

WASHINGTON, Oct. 20—
Abortion rights groups are finishing a season of legislative struggle on Capitol Hill that carries some grim omens for their next great battle: the attempt to have abortion services, for rich and poor alike, covered under a national health care plan.

Recent votes in the House and Senate upholding strict curbs on the Federal financing of abortion suggest that the center of political gravity has not shifted as much as many expected after the election of a President sympathetic to the cause of abortion rights.

Now, as abortion rights advocates turn to the far more sweeping legislation to overhaul the health care system, they face some difficult questions and strategic considerations. President Clinton's health plan would give them something they have ardently sought for almost two decades -- a system that would blur the existing line between the abortion options of the middle class and the poor.

But it also creates a complicated new issue for them because its unified system with subsidies for the poor will largely erase the line between Federal and private money in the insurance system.

The fears and concerns of the anti-abortion movement are a mirror image. Its leaders say they fear a significant, and lasting, expansion of abortion services if they are covered by a federally guaranteed benefits package. For years they have fought the idea of abortion becoming a routine medical service supported, directly or indirectly, by taxpayers.

The Administration has tried hard to keep the abortion issue from being at the center of the health care debate, but that has had little effect on the organized groups. Abortion rights advocates are trying hard to capitalize on the first President sympathetic to their cause in 12 years; abortion opponents are trying to hold the line after significant gains during the Reagan and Bush years.

Administration officials have indicated that they will submit a plan to Congress that covers abortions as a "pregnancy related service" in the basic benefits package. Most recipients of Medicaid, the health program for the poor, would be folded into the same regional insurance pools as everyone else, with access to the same basic benefits.

But the President's proposal is just the first step in a process that must go through Congress, and abortion rights groups face some formidable political obstacles, among them these:

*Can they overcome 17 years of Congressional opposition to federally subsidized abortions for the poor? Administration officials say that under the Clinton plan, the Federal Government will not actually pay for abortions for the poor, only for their insurance premiums. Abortion opponents see that as a distinction without a difference.

*If abortion rights forces cannot persuade Congress to cover abortions for poor women, can liberal Democrats accept a compromise in which abortion coverage is made available to middle-class women but not to the federally subsidized poor?

*How can abortion rights advocates deal, in general, with the objections of those who say they do not want their tax dollars connected to abortion services in any way? Under the Clinton plan, huge amounts of Federal money, including subsidies for the poor and for small businesses, would be mixed with private contributions in regional insurance pools.

*How much can abortion rights forces count on the President to back them? Already, some Democrats are suggesting that overhauling the health care system is a once-in-a-generation opportunity that should not be held hostage to a single issue. Upsetting the Balance

Representative Charles E. Schumer, a Brooklyn Democrat who has long been active on the abortion issue, said, "My worry, as somebody who's pro-choice and for funding, is that because it's going to be such a close and hard fought process, the health care bill's main proponents will say it's not worth the bother."

The politics of this struggle revolves around what many elected officials and analysts see as the basic dynamic of the abortion issue now: There is consensus in the polls and on Capitol Hill for keeping abortion legal, but that consensus has so far not extended to using Federal money for abortions in most circumstances.

The current health care system accommodates this political dynamic: poor women are covered by the Medicaid program. Each year since 1976 Congress has attached an amendment to the budget for that program named for its sponsor, Representative Henry J. Hyde, Republican of Illinois, that prohibits the use of Federal money for abortion in all but the most limited circumstances.

But the Clinton health care plan envisions folding most Medicaid recipients, and the Government money for their care, into the same regional health alliances as everyone else. This would give abortion rights forces a goal they have sought for 17 years: a health system that does not treat abortions for the poor differently. But it is bitterly opposed by abortion opponents.

"Being coerced through the tax code to subsidize someone else's abortion offends millions of people." Mr. Hyde said. "It's one albatross around the neck of this complicated, difficult proposal."

The issue could be avoided, he argued, by providing that "those people who want to purchase abortion coverage can do so at their own expense."

Efforts at finding a middle ground on this issue are still in the earliest stage. The Administration's approach so far is to present its plan as largely a continuation of the status quo: Most women now have such coverage in their private insurance plans, officials say, and will continue to receive it under the category of "pregnancy-related services." Lots of Apprehension

Officials have talked little about the financing. But when asked, they suggest that this system would be so fundamentally different from the present system that it would be impossible to restrict the use of Federal money as it is now restricted under Medicaid. "Now, Medicaid will essentially be paying a premium, and its recipients will be in the same alliances as everyone else," said Judith Feder, a Deputy Assistant Secretary of Health and Human Services.

From a political standpoint, Administration officials appear to be hoping that the system is far enough removed from a direct subsidy for abortion that the lawmakers in the middle will feel comfortable voting for it.

At the same time, both the President and Hillary Rodham Clinton, who is heading the Administration effort for passage of the health care plan, have emphasized that the plan will include a "conscience clause" allowing doctors and others to refuse to perform abortions.

Still, there is, as usual, much apprehension about this issue in Congress. Some lawmakers allied with the abortion rights groups say they will oppose any effort to restrict abortion services provided to poor women. And the abortion-rights groups say they are not in the mood to compromise on this issue. "Comprehensive means comprehensive," said Pamela Maraldo, the president of the Planned Parenthood Federation of America. "It means all women."